勃起功能障碍代表了前列腺癌（PCa）治疗的主要副作用，对男性的生活质量产生了负面影响。虽然放射治疗（RT）的进展使泌尿生殖系统和胃肠道毒性得到缓解，但在性生活质量方面并未显示出明显改善。本综述的主要目的是评估与勃起功能障碍发生相关的性结构剂量容积参数。我们搜索了PubMed数据库和ClinicalTrials.gov直到2023年1月4日。符合条件的研究包括报道对性结构所施加的剂量对性功能影响或创新性性结构保护方法的可行性的研究。性保护策略涉及四个性器官。现代PCa RT试验中平均阴茎基部剂量超过20Gy表明勃起功能障碍的预测性。在内部阴道动脉上保持≤36Gy的D100％，在5年内88％的患者中有着勃起功能的保留。磁共振引导的放射治疗似乎可行于神经血管束的保护，但其临床影响仍待解答。在PCa RT期间对睾丸的剂量通常保持在<2Gy，并产生睾酮水平下降从-4.6％到-17％，不太可能产生任何临床影响。当前数据突出了PCa RT的性保护的技术可行性。由剂量施加给性结构导致的勃起功能障碍的比例仍然广泛不明。虽然随时间推移保持性功能的能力受到年龄或合并症等因素的影响，但只有少部分患者可能从性保护RT中获益。放射治疗技术的进步使得对性结构施加的剂量显著降低成为可能。虽然众所周知，随着年龄增长性功能会下降，但对于前列腺癌放射治疗来说，保留性结构可能只对某些患者有益。版权所有©2023年欧洲泌尿学协会。由Elsevier B.V.出版，保留所有权利。

Erectile dysfunction represents a major side effect of prostate cancer (PCa) treatment, negatively impacting men's quality of life. While radiation therapy (RT) advances have enabled the mitigation of both genitourinary and gastrointestinal toxicities, no significant improvement has been showed in sexual quality of life over time.The primary aim of this review was to assess sexual structures' dose-volume parameters associated with the onset of erectile dysfunction.We searched the PubMed database and ClinicalTrials.gov until January 4, 2023. Studies reporting the impact of the dose delivered to sexual structures on sexual function or the feasibility of innovative sexual structure-sparing approaches were deemed eligible.Sexual-sparing strategies have involved four sexual organs. The mean penile bulb doses exceeding 20 Gy are predictive of erectile dysfunction in modern PCa RT trial. Maintaining a D100% of ≤36 Gy on the internal pudendal arteries showed preservation of erectile function in 88% of patients at 5 yr. Neurovascular bundle sparing appears feasible with magnetic resonance-guided radiation therapy, yet its clinical impact remains unanswered. Doses delivered to the testicles during PCa RT usually remain <2 Gy and generate a decrease in testosterone levels ranging from -4.6% to -17%, unlikely to have any clinical impact.Current data highlight the technical feasibility of sexual sparing for PCa RT. The proportion of erectile dysfunction attributable to the dose delivered to sexual structures is still largely unknown. While the ability to maintain sexual function over time is impacted by factors such as age or comorbidities, only selected patients are likely to benefit from sexual-sparing RT.Technical advances in radiation therapy (RT) made it possible to significantly lower the dose delivered to sexual structures. While sexual function is known to decline with age, the preservation of sexual structures for prostate cancer RT is likely to be beneficial only in selected patients.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.